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Of 100 patients with lateral epicondylitis who were referred to the clinics, 88 met eligibility criteria and 60 agreed to participate in the trial (Figure). Most participants were middle-aged women whose symptoms had persisted for several months (Table 1). Most baseline characteristics for the 2 groups appeared to be similar. Table 2 shows mean scores for the VAS at baseline and at each follow-up assessment. At 4 weeks, the botulinum group showed a statistically significant improvement in VAS pain assessments over the placebo group (P < 0.001), which was maintained at 12 weeks (P = 0.006). The mean VAS scores were 65.5 mm and 25.3 mm at baseline and at 4 weeks for the botulinum group and 66.2 mm and 50.5 mm for the placebo group, respectively (between-group difference of changes, 24.4 mm [95% CI, 13.0 to 35.8 mm]). At week 12, the mean VAS scores were 23.5 mm for the botulinum group and 43.5 mm for the placebo group (between-group difference of changes, 19.3 mm [CI, 5.6 to 32.9 mm]). Grip strength was not statistically significantly different between groups at any time.

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Wong et.al did a placebo controlled trial of botulinum toxin for lateral epicondylitis. I have often treated tennis elbow with an injection of lidocaine and steroids. In his editorial Pullman asserts that BTx injections are "less harmful" than corticosteroids. Since corticosteroids are a standard treatment for this condition, the study would have been more useful if they had compared corticosteroids with BTx. rather than placebo.

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Summary for Patients

The summary below is from the full report titled “Treatment of Lateral Epicondylitis with Botulinum Toxin. A Randomized, Double-Blind, Placebo-Controlled Trial.” It is in the 6 December 2005 issue of Annals of Internal Medicine (volume 143, pages 793-797). The authors are S.M. Wong, A.C.F. Hui, P.-Y. Tong, D.W.F. Poon, E. Yu, and L.K.S. Wong.

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